摘要
目的探讨艾滋病患者合并脑部感染性病变的CT影像特征,提高艾滋病病人合并脑部感染CT诊断准确率。方法对经血清HIV抗体检查阳性及国家指定的实验室证实的HIV/AIDS并伴有神经症状的患者12例,进行Philips 16排CT颅脑扫描,以OM为基线,层厚为6 mm,扫描后对感兴趣区进行薄层重建,所有患者另行CT增强扫描。扫描后将图像推至后处理工作站及PACS系统,由两名具有5年以上工作经验的高年资医师采用双盲法对图像进行分析诊断,并记录所有患者的姓名、年龄、性别等相关信息。所有患者均签署知情同意书。最后对所有数据进行统计学分析。结果 12例HIV/AIDS患者中,男8例,女4例,平均年龄37岁(21~59岁)。主要临床表现为头痛、发热、呕吐者6例;颈部淋巴结肿大、头痛者3例;发热、记忆力减退者1例;神志改变、记忆力减退者2例。脑部CT表现主要分为以下3种:(1)HIV脑炎8例:本组患者中2例表现为双侧大脑半球白质对称性密度减低,4例为双侧大脑半球不对称性斑片状低密度影,2例表现为脑沟裂池增宽等脑萎缩改变,所有病例占位效应不明显,8例患者增强扫描后均无强化;(2)巨细胞病毒脑炎2例:本组患者中1例表现为右侧顶叶结节样病变,1例表现为左侧基底节区多发结节样病变,增强后病变呈结节样均匀或不均匀性强化;(3)HIV合并弓形体脑炎2例:1例左侧大脑半球见大片指压性水肿带,其内见等密度结节,1例为左侧基底节区等密度结节伴周围低密度区,增强后可见环状强化影,有轻度占位效应。结论 CT扫描对艾滋病合并中枢神经系统感染性病变的诊断和治疗有重要的临床指导意义,但鉴于CT表现缺乏特异性,最终诊断需结合临床及血清免疫学检查。
Objective To investigate the CT imaging features of AIDS patients with brain in- fectious lesions, and improve the accuracy of CT diagnosis in AIDS patients with brain infec- tion. Methods Brain scan with Philips 16 row CT was performed in serum HIV antibody posi- tive patients confirmed by the national laboratory confirmed HIV/AIDS. All scans were taken as OM baseline, and the layer thickness was 6 mm. After scanning, the area of interest were reconstructed into thin layer images. All patients underwent CT enhanced scan. After scanning the images were transmitted to the post-processing workstation and PACS system. Two senior doctors with more than 5 years working experience were employed to analyze and diagnose the images by double blind method. All patients＇ name, age, gender and other related information were recorded. All patients signed informed consent. Finally, all data were dealt with statistical analysis. Results Among 12 patients with HIV/AIDS, there were male 8 cases and female 4 cases, with an average age of 37 years （ranging from 21 to 59 years）. The main clinical mani- festations were headache, fever and vomiting in 6 cases. Cervical lymph nodes enlargement, headache in 3 cases. Fever, loss of memory in 1 case. CT findings of the brain was divided in- to the following 3 kinds： （1）HIV encephalitis in 8 cases. In this group, there was white matter symmetry density decreased in 2 cases. Four cases showed asymmetry patchy low-density shad- ow in bilateral cerebral hemisphere. Two cases showed cerebral sulci widened and brain atro- phy. All eases without obvious space occupying effect. Eight patients were not enhanced after enhanced scan; （2）Cytomegalovirus encephalitis in 2 cases. In this group of patients, 1 case showed right parietal nodular lesions. One case showed multiple nodular lesions in the left basal ganglia and lesions showed nodular homogeneous or inhomogeneous enhancement after enhance- ment; @HIV combined with Toxoplasma encephalitis in 2 cases. In 1 case the left hemispher
出处
《哈尔滨医科大学学报》
CAS
2017年第6期540-542,549,共4页
Journal of Harbin Medical University
